Non-Disclosure Investigator

Position Purpose

The Non-Disclosure Investigator is responsible for identifying and investigating suspected cases of member non-disclosure, misrepresentation, or omission of material medical information during the application process for medical scheme membership. The role is responsible for assessing whether medical conditions, symptoms, treatments, or consultations existed prior to scheme application and whether these were appropriately disclosed during underwriting. The investigator supports the protection of the Scheme against financial and underwriting risk through detailed clinical, claims, and membership investigations while ensuring compliance with legislation, scheme rules, and governance requirements.

Experience

Extensive Experience (3-5 years) in Hospital authorisations, Claims Investigations, non-disclosure investigations, with demonstrated expertise in gathering evidence, analysing clinical information and identifying risk is essential...